12060026 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10969 NORTHSHORE SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12060026
O\YNER'SNAMF,: BARRErr JOYETAL PO BOX 1668 DATE: ISSUED:06/052012
OWNF.R'SPIIONF.: 4089963712 SAN.IOSE,CA 95109 PIIONF.NO:(4n8)278-0130
LLI+CENSEED CONTRACTOR'S/DECL!M(TIONBUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
`
License Clercs —r / Lic.0 - I L —1 f/?? cok r r F
Cccn MECH RESIDENTIAL COMMERCIAL
Contractor \ J,` Date 6/—Jr�/I
hereby affirm that I am licensed under the provisions of Chapler 9 JOB DESCRIPTION: RE-ROOFTEAR OFF EXISI"ING CAI:SI IAK17 ROOFING
(commencing with Section 7000)of Division SYSTEM,INSTALL 30p FELT UNDERLAYMENT AND INSTALLthe Business&Professions GAF GRAND CANYON SIiINGLES,COLOR:STONFWOOD CLASS A 11{ 9W
Cade and that my license is in full farce and a effefe ct.
I hereby affirm under penally of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the labor Code,for the performance of the work for which(his Sq.F1 Floor Area: Valuation:$6500
permit is issued.
APPLICANTCERTIFICATION APN Number:31638025.00 Occupancy Typc:
I certify that I have read this application and state that the above information is
cored.I agree to comply with all cit)'and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indenosts.a and expenses
nseswhichmaythe crueagCupcnino idCityinl consequence of
WITHIN Igo DAYS OF PERMIT ISSUANCE OR
cosu,and expenses which may accrue against said City inconsequence o(the
granting of this pennon. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9,18.
Signature Date
4—y-, /1 Issued by: )� /✓ ATG/T Date:
❑ OWNF. I1ILDER DECLARATION
RF:ROOFS:
hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior mm any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agrcx:to remove all new materials for
h as owner of the properly,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is no(intended or offered for sale(Sce.7044,
Business&Professions Code) Signature of Applicant: Date',6— 'fZ
L as owner o1'the property,am exclusively contracting with licensed conlractors to
constmet the project(Sec.7044.Business&Professions Code).
ALL ROOF CO\'ERINC.S'I'O RE CLASS",\"OR RFa"fFR
I hereby affirm under penalty of perjury one of the following three
declarations: IL\%,\RDOUS MATERIA S DISCLOSURE
I have and will maintain a Cenilicalc of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work lir which this permit is issued. California IIea11h&Safety Code.Sections 25505,25533,and 25534, 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Cade,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emil hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
not employ toy person in any manner so as to become subject to the Worker's Ilealth&Safely Code,Sections 25505,25533,and 25534.
Compensation Ia%%s of Califomia If,after making this certificate of exemption,I
became subject to the Worker's Compensation provisions of the Labor Code,I muss
Owneror hori enl: S /,L
APPLICANT CERTIFICATIONCERTIFICATIONforthwith comply,ith such provisions or this permit shall be deemed revoked. Date:
CONS'1'RUC'I'ION LENDING AGENCY
I certify that I have read[his application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of swrk's
correct. I agree to comply with all city and county ordinances and sate laws relating for which this permit is issued(Sec.3097.Civ C-)
to budding construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above nmenUoncd property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this Permit.Additionally,the applicant understands and will comply ,\NC.IIITF,C'I"S DECLARATION
with all non-point source regulations per the Cupenino Municipal Code,Section
9.18. 1 understand nay plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: alk: Lot:
APN 31638025.00
DATE ISSUED. . . . . . . : 06/05/2012
RECEIPT #. . . . . . . . . BS000017000
REFERENCE ID # . . . : 12060026
SITE ADDRESS 10969 NORTHSHORE SQ
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER BARRETT JOY ET AL
ADDRESS . 10969 NORTHSHORE SQ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-0533
RECEIVED FROM . . . . : AL DIAZ
CONTRACTOR DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
- ADDRESS . . . . . . . . . PO BOX 1668
CITY/STATE/ZIP _ . . : SAN JOSE, CA ,95109
TELEPHONE (408) 278-0330
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ----------
---------- ---------- ----------
1BCBSC VALUATION 6,500 . 00 1. 00 0. 00 1 .00 0. 00
1BSEISMICR VALUATION 6, 500.00 0 .65 0 . 00 0 . 65 0 . 00
1REROOFRES SQ .FEET 14 . 00 196 . 00 0. 00 - 196_00 0_00
---------- ----------
TOTAL PERMIT 197. 65 0. 00 197 .65 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------—-----------—---
-- ----------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
19 ADDRESS: 10969 Northshore Sq DATE: 06/05/2012 REVIEWED BY: Sean
APN: BP#: -VALUATION: $6,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFD or Duplex PERMITTVPE: 1SFDWLR00
WORK Tear off existing cal-shake roofingan system, install 30#felt underla ment and install GAF Grand Canon
SCOPE shingles, color: Stonewood.
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,400
,Undr. 1'Lm , 'h:rk P/.....b. Plan Cho A liter_ l'lm Cirr,:k
Ilr,:l,_ l'.a iuB Fvr.- 111.....1, 1"'mil
l hluv-,1/erh. ln,vp. Oder 1'1.m6 Imp. i Jrbvr 6:lrr. Iml.
Jld,h.imp. lre' Plun.h. luny. F2n': Pa,v. Lr.,p. h4',..
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelimina information available and are only an estimate Contact lite Dept for mh/n7 info.
FEE ITEMS (Fre Resolnrion 11-053 Eff. 711/11) FEE QTY/FEE MISC ITEMS
/Trip r hr(G hir:
Slip/:l. PC l-'r.r
l'lrmlh I/"' h.' /eu
Permit Fee: $196.00
l el m it l ce.
C'ua�u rn lion Tccr:
:I rlrnini.vu-rni r,r l ,rr:
Work Without Permit? 0 Yes E) No $0.00
,Irh,rnnall'Guuriu,� Fres:
7S;nad I?nrrun uumivn Fc s;
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Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
BWE4 Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $197.65 $0.00 TOTAL FEE: F $197.65
Revised: 05/01/2012
i'
REROOF PERMIT APPLICATION =
CO!-'MUM 1Y DEVELOPMENT DEPARTMENT • BUILDING DIViSIGN
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